Tuberculous discitis and osteomyelitis

Case contributed by A.Prof Frank Gaillard

Presentation

Three weeks of increasing back pain.

Patient Data

Age: 40 years
Gender: Male

The L2 vertebral body is slightly sclerotic with a lucency projecting over its mid portion. There is mild loss of disc height of the L2/3 level. 

A well-defined oblique tubular lytic process extending through the L2 vertebral body with foci of ill-defined calcification. On MRI this lesion is seen to be very high T2 signal, without rim enhancement and communicating with a 6.4 x 3.5 cm right psoas collection. This  collection extends through the centre of the L2/3 disc where it breaches the superior endplate of the L3 vertebral body. There is vivid contrast enhancement and abnormal signal within the remainder of the L2 and L3 vertebral bodies extending for a short distance into the pedicles of each.

No other vertebral body lesion. No canal stenosis or epidural collection identified.

This patient went on to have both a bone biopsy and a paravertebral collection aspiration. 

NUCLEIC ACID TESTING (ON PUS ISOLATE) - Mycobacterium Sp. by DNA Probe: Positive for M. tuberculosis complex

MYCOBACTERIUM CULTURE SCREEN - MGIT bottle <7 days: POSITIVE

MYCOBACTERIAL CULTURE - Acid Fast Bacilli: ISOLATED

Case Discussion

Typical features of TB discitis/osteomyelitis with associated psoas abscess. 

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Case information

rID: 20324
Case created: 13th Nov 2012
Last edited: 23rd Jul 2016
Inclusion in quiz mode: Included

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